Sharing Knowledge: Achieving Breakthrough Performance

2010 Military Health System Conference

Implementation of a Centralized Patient Transfer Center:

Naval Medical Center San Diego

January 25, 2011CDR Sarah Mittemeyer Shea, NC, USNThe Quadruple Aim: Working Together, Achieving Success

2011 Military Health System Conference

Improving the Care Experience of Patients and their Families

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1. REPORT DATE 25 JAN 2011 2. REPORT TYPE

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4. TITLE AND SUBTITLE Implementation of a Centralized Patient Transfer Center: Improving theCare Experience of Patients and their Families

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7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Naval Medical Center,San Diego,CA,92134

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13. SUPPLEMENTARY NOTES presented at the 2011 Military Health System Conference, January 24-27, National Harbor, Maryland

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Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18

2011 MHS Conference

Objectives

Identify 2 goals that NMCSD has accomplished with the institution of the Transfer Center

Identify 2 parallels between our experience and yours that open the potential for change

Identify 3 areas of the Quadruple Aim that the Transfer Center has addressed

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2011 MHS Conference

Everyone Has A Past

The Ugly Truth:– Patients receive care in

Civilian EDs and are often admitted w/o our visibility

– Civilian EDs are motivated to clear their beds ASAP

– Numerous portals of entry– Decentralized access– Cumbersome process– Did nothing to promote

collegial relationship with community facilities

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2011 MHS Conference

210 minute average time to transfer decision At least 11 different entry points Transfers were mostly dependent upon “who

you know” hook-ups No official Command policy existed Transfer process was chaotic and variable. Inability for Admissions to track incoming

patients and coordinate bed availability Lack of coordination resulted in unexpected

arrivals who often ended up in MTF ED

Where We Were

2011 MHS Conference

Where Did We Want To Be

•Increase case mix/complexity for GME

• Maximizeinpatient

capacity

•Continuity of Care•Centralized and Streamlined

•Developcollegial

relationships

•Positive patient experience

•Rapid decisionsand transfers•Take care of

our patients

2011 MHS Conference

Leaving the Past Behind

Establishing an Exciting Future:– (619) 532-NAVY– 24 Hour access to the

Transfer Center agent– Directed a 10 Minute

response time for on-call physician to respond

– Facilitation of direct Dr to Dr contact for acceptance

– Transfers tracked and reported to leadership

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2011 MHS Conference

Components of Change

• Key NMCSD players included in planning• CDR Love (ED Chair), CAPT Finch (MSMO)

CAPT Stang (DNS), CDR Shea (UM), LTjg Baumbach (PAD), RN Julie Bishop (DHB), RN Kathy Yetz (UM/UR), Carmen Hoisseny (PAD)

• Attended a Transfer Center Conference• Visited Naval Medical Center Portsmouth• Consulted with our community partners in the

private sector• Aggressive internal education and marketing

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2011 MHS Conference

Forging Forward

Standard Operating Procedures (SOP) and training established – Customer service experience for Transfer Center – Efficient confirmation of eligibility of care– Efficient evaluation by an on-call resident

physician for transfer– Required 10 minute response time to the Transfer

Center by resident-on-call, and facilitation of Dr to Dr contact between NMCSD and referring ED within 20 minutes

– Nurse of the Day consulted throughout process8

2011 MHS Conference

Transfer Center Education

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Outside Inside

2011 MHS Conference

Tracking Success

Directorate of Healthcare Business developed key metrics compiled weekly and reported to NMCSD Executive Steering Council– Total calls in-bound– # patients accepted for transfer– # patients declined transfer by NMCSD and why

• Directors are required to be able to address reason for declination

– # of Active Duty or non-Active Duty– Average time from initial contact to transfer

decision10

2011 MHS Conference

Outcomes of Change

• TRICARE beneficiaries/month from civilian EDs – Baseline:

• Patient Admin tracks approximately 8/month – 3 week mark:

• 35 transfers recorded– Current:

• Average # of transfers = 52/month

• Transfer decision time decreased 86% – From approximately 4 hours (210 min) to 30 min

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2011 MHS Conference

Over Time

12

0

10

20

30

40

50

60

70

80

FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

NMCSD Transfer Center

# Accepted Monthly Ave. Accept Time (min)

2011 MHS Conference

Summary

Recapture of TRICARE beneficiaries promoting maximal MTF utilization and financial responsibility for the DOD Healthcare system

Fast and efficient process for civilian EDs to transfer patients to NMCSD were met

Cumbersome process streamlined to a single portal and standardized process

Better experience for our beneficiaries seen in civilian EDs– Bringing our beneficiaries back to a hospital system

they know and that knows them13

2011 MHS Conference

Challenges!

Our Challenge to you!– Look inward! With an objective and discerning

approach, find the inefficiencies (big and small) in processes at your Command that need improvement

– Look outward! Many enterprises are doing what we do (DoD, VA, Civilian); reach out and learn what methods they use to accomplish similar goals

– Think outside the box! Consider, innovate and ACT on areas in need of help with new ideas that make the outcome better than expected

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